Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan

Background EMR and endoscopic submucosal dissection (ESD) are now being increasingly used for the treatment of esophageal cancers. However, their efficacies in smaller lesions have not been compared. Objective For effective use of these methods, we compared the results of ESD and 2 major EMR methods for treating esophageal cancers of ≤20 mm. Design A retrospective study. Setting A cancer-referral center. Patients A total of 136 patients with 171 lesions ≤20 mm who presented between January 2002 and October 2007 were enrolled. Main Outcome Measurements En bloc and curative resection. Results Of the 171 lesions, 168 were squamous-cell carcinoma and 3 were adenocarcinoma. The en bloc resection rates decreased in the order of ESD (100%), EMR using a transparent cap (EMRC) (87%), and 2-channel EMR (71%). However, the differences showed only marginal significance. The curative resection rate of ESD (97%) was significantly higher than those of the other 2 methods. Furthermore, the curative resection rate of EMRC (71%) was significantly higher than that of 2-channel EMR (46%). In lesions Limitations A single-center, retrospective analysis. Conclusions ESD was found to be the best endoscopic resection method, even for smaller esophageal cancers. EMRC would be a good alternative to ESD for lesions